Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis

• Published in: BMC sports science, medicine & rehabilitation Vol. 15; no. 1; pp. 9 - 12
• Main Authors: Prudêncio, Diego Ailton, Maffulli, Nicola, Migliorini, Filippo, Serafim, Thiago Teixeira, Nunes, Luis Felipe, Sanada, Luciana Sayuri, Okubo, Rodrigo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 26.01.2023; BioMed Central; BMC
• Subjects: Achilles tendinopathy; Ankle; Ankle injuries; Bias; Comparative analysis; Exercise; Exercise therapy; Injuries; Intervention; Meta-analysis; Pain; Performance evaluation; Physiotherapy modalities; Review; Systematic review; Tendons; Physiotherapy modalities; Review; Achilles tendinopathy; Ankle injuries; Exercise therapy
• ISSN: 2052-1847; 2052-1847
• DOI: 10.1186/s13102-023-00618-2

Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented "some concerns", and 37.5% (five and three articles, respectively) presenting "high risk" of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was - 1.21 (- 2.72 to - 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.